How to Identify and Help a Health Care Professional with a Substance Use Disorder – PART ONE
[Note to Reader: This post is “Part One” of a 2-part blog-post. “Part Two” will follow shortly after publication of this post.]
The nature of addiction has been studied by scientists and researchers for decades. The American Psychiatric Association describes it as “a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems.”
While a great deal of media attention has been given to the current opioid epidemic in the U.S. (as well as the abuse of other prescription drugs), it may be surprising to find out that health care professionals—including physicians, surgeons, pharmacists and nurses—are as likely as anyone else to abuse drugs.
Certainly, the vast majority of healthcare practitioners act responsibly with their dispensing of prescription medications, while maintaining a professional, medically sound approach to their use. However, given many have easy access to prescription medications, there are those who—for the sake of relief from stress, self-medication or to temporarily improve alertness on the job—end up abusing and/or diverting prescription drugs.
What are some of the indicators that one of your colleagues or co-workers has a substance abuse problem?
First of all, it should be noted that all healthcare workers have a legal and ethical responsibility to uphold the law and to help protect patients and the community at large from drug abuse. This includes the professional responsibility of prescribing and dispensing all drugs (especially controlled substances) appropriately, safeguarding against any abuse and making sure patients have medication available when they need it.
That being said, the D.E.A. (U.S. Drug Enforcement Administration) has identified a number of signs you may see occur in your workplace or observe in a colleague or co-worker, indicating he/she may have a substance use disorder:
- Work absenteeism – absences without notification and an excessive number of sick days used;
- Frequent disappearances from the work site, having long unexplained absences, making improbable excuses and taking frequent or long trips to the bathroom or to the stockroom where drugs are kept;
- Excessive amounts of time spent near a drug supply. They volunteer for overtime and are at work when not scheduled to be there;
- Unreliability in keeping appointments and meeting deadlines;
- Work performance which alternates between periods of high and low productivity and may suffer from mistakes made due to inattention, poor judgment and bad decisions;
- Confusion, memory loss, and difficulty concentrating or recalling details and instructions. Ordinary tasks require greater effort and consume more time;
- Interpersonal relations with colleagues, staff and patients suffer. Rarely admits errors or accepts blame for errors or oversights;
- Heavy “wastage” of drugs;
- Sloppy recordkeeping, suspect ledger entries and drug shortages;
- Inappropriate prescriptions for large narcotic doses;
- Insistence on personal administration of injected narcotics to patients;
- Progressive deterioration in personal appearance and hygiene;
- Uncharacteristic deterioration of handwriting and charting;
- Wearing long sleeves when inappropriate;
- Personality change – mood swings, anxiety, depression, lack of impulse control, suicidal thoughts or gestures;
- Patient and staff complaints about health care provider’s changing attitude/behavior; and/or,
- Increasing personal and professional isolation.
In Part Two of this blog-post, we’ll explore whether or not you have a responsibility to “do” anything—if any of the behaviors or incidents mentioned above are observed—and what you can do to help your colleague or co-worker.
 Bennett, J., & O’Donovan, D. (2001). Substance misuse by doctors, nurses and other healthcare workers. Current Opinion in Psychiatry, 14, 195–199.